Pre-Authorization Registered Nurse - Remote

Overview

Become a part of our caring community and help us put health first. Humana Healthy Horizons is seeking a Pre-Authorization Nurse 2 who will review prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder.

In Short

• Review prior authorization requests for appropriate care.
• Complete medical necessity reviews using clinical judgment.
• Educate providers on utilization and medical management processes.
• Maintain clinical information in medical management systems.
• Work independently and as part of a team.
• Utilize MS Office tools effectively.
• Remote work from Oklahoma with minimal travel.
• Participate in training and adhere to work schedule.
• Support HIPAA compliance in all communications.
• Engage in continuous learning and development.

Requirements

• Active RN license in Oklahoma or Compact.
• Minimum two years of clinical nursing experience.
• Working knowledge of MS Office and technical troubleshooting.
• Ability to work independently under general instructions.
• Experience in Medicare/Medicaid preferred.
• Certification in Case Management is a plus.
• Bilingual candidates are preferred.
• Experience with MCG or Interqual guidelines.
• Triage experience is a plus.
• Health Plan experience is an advantage.

Benefits

• Health benefits effective day 1.
• Paid time off and holidays.
• 401(k) retirement savings plan with employer match.
• Tuition assistance and scholarships for dependents.
• Parental and caregiver leave.
• Employee charity matching program.
• Career development opportunities.
• Recognition pay.
• Flexible work arrangements.
• Access to wellness resources.